Stroke and TIA Flashcards
What is the second leading cause of death worldwide?
Stroke
What is dysphasia?
Language disorder
Deficiency in generation of speech
Sometimes also comprehension
Due to brain disease/damage
What is expressive dysphasia?
Difficulty in putting words together to make meaning
What is receptive dysphasia?
Difficulty in comprehension
What is dysarthria?
Speech disorder caused by disturbance of muscular control
What is dysphonia?
Difficulty speaking due to physical disorder of
- Mouth/
- Tongue/
- Throat/
- Vocal cords
What does the acronym FAST stand for?
F - facial weakness - Can person smile - Has mouth/eye drooped A - arm weakness - Can person raise both arms? S - speech difficulty - Can person speak clearly and understand what you say? T - time to act fast
Why is it important to know the exact time of onset of symptoms in stroke?
Because treatment available very time critical
How can you assess facial droop?
Asymmetry in nasolabial folds
If subtle, get patient to smile
What type of lesion is indicated if the upper half of the face is spared?
Upper motor neuron lesion on contralateral side
What type of lesion is indicated if the whole half of the face is affected?
Lower motor neuron lesion on ipsilateral side
How can arm drift be used to assess weakness in an arm in the assessment of a possible stroke?
Ask patient to close eyes and hold out both arms, palms facing up
Arm on weaker side pronates and drifts downwards
What type of dysphasia Broca’s dysphasia?
Expressive
What type of dysphasia is Wernicke’s dysphasia?
Receptive
What is a silent stroke?
May not have much of deficit
May be difficult to elicit deficit if present even 1 hour later
Still have tissue infarction on imaging
Define stroke
Brief episodes <24 hours with brain injury
Define transient ischaemic attack (TIA)
Brief neurological episodes, usually <24 hours, without damage on imaging
What does a code stroke in the emergency department mean?
Urgent triage and high priority Mobilise stroke team IV - Glucose - Routine biochemistry - Full blood exam (FBE) ECG Accurate clinical diagnosis - Exclude mimics Urgent CT
Why is blood glucose measured in a possible stroke patient?
Hypoglycaemia = great mimic, especially of stroke
Why is an FBE performed in a stroke patient?
Platelet levels - If known coagulopathy - On anticoagulant Include INR Both assess risk of bleeding because of thrombolysis
Why is a CT scan performed?
To exclude haemorrhage
Doesn’t matter if you accidentally thrombolyse a TIA/stroke mimic
- But important not to thrombolyse haemorrhage
When does thrombolysis lose its benefit-to-risk ratio?
After 4.5 hours
How do you predict a stroke has occurred, and not a mimic?
Exact time of onset Patient could recall exactly what they were doing when symptoms started Well in last week Definite focal symptoms/signs Worse NIH stroke score (NIHSS)
How do you predict a mimic has occurred, and not a stroke?
Known cognitive impairment Lost consciousness/seizure at onset Patient could still walk No lateralising symptoms Confusion Non-vascular, or no neurological signs
